Our journey into this amazing fellowship began when Dr. Parag Sancheti informed us that me and Dr. Vishnu Senthil were the ‘chosen ones’ (after duly completing the selection process) for the year 2023. We were informed that the APAS fellowship 2023 includes traveling to Chennai, Kuala Lumpur, Sydney, Jakarta, Solo, and Surabaya over four weeks and finally attending the APAS Annual Conference at Cebu. We were asked to make all the necessary traveling arrangements according to our convenience and coordinate with the local hosts.

Chennai, India (24th - 30th July 2023)

Our first part of this fellowship began at the Asian Joint Reconstruction Institute under Dr. Vijay Bose, Dr. P Suryanarayan, and Dr. Kalaivanan. We were introduced to a new paradigm called functional 3-dimensional balancing in Total Hip Replacement by Dr. Vijay Bose. He beautifully demonstrated this philosophy in several different case scenarios that included a dysplastic hip, ankylosed hip, coxa vara, and primary hip osteoarthritis post-AVN. In knee Arthroplasty, we observed a case of total knee replacement performed with adjusted mechanical alignment principles, a fixed-bearing Unicompartment knee replacement, and a second-stage revision knee arthroplasty. Along with his fellows, we participated in detailed pre-operative planning in all of his Arthroplasty cases. Dr. Bose also presented to us some of his curated collection of scientific talks on Hip arthroplasty.

Left to Right: Dr. Kalaivanan, Dr. Vishnu (APAS fellow), Dr. Vijay Bose, and Dr. Sandesh (APAS fellow) at AJRI (SIMS), Chennai.

Assisting cases in the theatre and lectures from Dr. Vijay Bose to APAS fellows at AJRI, Chennai.

Kuala Lumpur, Malaysia (31th July- 6th August 2023)

Our first international visit of this fellowship was to Prof. David Choon at Quill Orthopaedic Specialist Centre. We observed six conventional mechanical alignment total knee replacements performed with all-poly tibial components. We also visited Sunway Medical Center and observed Dr. Chua Hwa Sen perform Robotic total hip replacements using the MAKO (Stryker) system and Robotic knee replacement using the ROSA (Zimmer) system. We also visited the University Malaya Medical Center where Dr. Veenesh showed us follow-up cases of Arthroplasty visiting the public hospital. Dr. Vishnu also assisted Prof. David Choon in an interesting revision Hip arthroplasty case. Prof. David Choon took us around Kuala Lumpur city and also made wonderful arrangements for us to visit the historical city of Melaka. We also had a wonderful dinner with all these faculties arranged by Prof. David Choon.

With Prof. David Choon at Quill Orthopaedic Specialist Centre, Kuala Lumpur, Malaysia.

With Dr. Chua Hwa Sen at Sunway Medical Centre, Kuala Lumpur, Malaysia.

Lunch with Dr. Chua and his team; Dinner with Prof. Choon and his wife, Dr. Chua and Dr. Veenesh.

Sightseeing in Kuala Lumpur and Melaka, Malaysia.

Ipoh, Malaysia (9th – 12th August 2023)

Dr. Vishnu left by train to Ipoh to meet Dr. Vasan Sinnadurai.

Dr. Vishnu: “I was picked up by Dr. Vasan’s assistant at the railway station. We went to the hotel and there was a social dinner with Dr. Vasan at a heritage club that was more than 150 years old. The next day I visited the public hospital and met Dr. Fu. There was a list of cases that included both hip and knee replacements for me to scrub in. Replacements done at the public hospital with different kind of implants and instrumentation in a low-resource setting was very interesting and informative. The next day was spent with Dr. Vasan at his outpatient clinic. We had lunch at a local Indian restaurant and dinner at a Malaysian brewery. On the last day, I embarked on my journey to Jakarta, Indonesia which included a bus journey with a scenic landscape of Malaysia from Ipoh to Kuala Lumpur.”

Dinner with Dr. Vasan at the Ipoh Club and a Public hospital Visit with Dr. Fu.

Sydney, Australia (7th - 13th August 2023)

I was pleasantly surprised to see Dr. Rami Sorial had personally come to receive me at the Sydney Airport. He took me to his magnificent home, introduced his family, and served me a delicious vegetarian home-cooked meal. The next day I visited Mater Private Hospital and observed two bilateral robotic knee replacements performed by Dr. Matt Lyons and his team using the Velys (Synthes) system. The following day, I tagged along with Dr Rami and his team at Napean Private Hospital at Penrith. I observed him perform a total hip replacement with Patient-Specific Instrumentation (PSI), two total knee replacements using the ROSA (Zimmer) system, and a mobile-bearing Oxford Unicompartment replacement. On the third day, I met Dr. Simon Coffey. He introduced me to the inverse kinematic alignment in total knee replacement and saw him perform a few cases using the OMNIBotics (Corin) robotic system. I also had some spare time to visit the spectacular wilderness of the Blue Mountains, the iconic Sydney Harbour Bridge, the Opera House, and the vibrant Bondi Beach. There was also a wonderful faculty dinner with Dr. Rami and his team members at a local Greek restaurant.

With Dr. Rami Sorial and Dr. Simon Coffey at Napean Private Hospital, Penrith, Sydney.

Faculty dinners at Sydney with Dr. Rami Sorial and his team.

Jakarta, Solo and Surabaya, Indonesia (14th - 20th August 2023)

In Jakarta, we visited Mitra Keluarga Private Hospital and assisted Dr. Andito in a bilateral total knee replacement. We also met Prof. Dr. Nicolaas Budhiparama at Medistra Hospital. He had arranged an Indonesian Hip and Knee Surgeons meeting and allowed us to present our research work and discuss interesting clinical cases. Along with him, there was a faculty dinner with Dr. Kiki, Dr Ricky and Dr Imelda. The next day we visited Fatmawati General Hospital and observed one total hip replacement with Dr Jamot. The same day we left on a train to Solo. At Prof. Dr. R. Soeharso Orthopaedic Hospital we met Prof. Dr. Asep Santoso and faculty members of the Adult Reconstruction division. We assisted Dr. Asep in a total hip replacement surgery for a complex dysplastic hip. The next day I left for Surabaya. At Dr. Soetomo General Hospital, in a weekly Orthopaedic and Traumatology Department scientific meeting, I presented a case to the residents. I also assisted Dr. Zaim Chilmi in a total hip replacement for a complex neglected acetabular fracture. There was a wonderful faculty dinner with Dr. Kukuh and other faculty members.

Faculty dinner @ Jakarta, Solo, and Surabaya, Indonesia.

Cebu, Philippines (21st - 23rd August 2023)

The final destination of this traveling fellowship was Cebu, Philippines where the APAS Annual Scientific Conference was organised. Besides wonderful scientific sessions, we met several distinguished faculty members and delegates from different countries who shared their experiences and knowledge with us. It was a perfect platform to forge new friendships and strengthen interpersonal and professional relationships.

Fellowship award night at Cebu, Philippines with Dr. Rami Sorial, Dr. Bharat Mody, and Dr. Parag Sancheti.

This traveling fellowship was truly an enriching experience that gave us a perspective on the current trends in the field of Arthroplasty in the Asia Pacific region. With an emphasis on conceptual thinking and evidence-based techniques, this fellowship has immensely shaped our understanding of Hip and Knee Arthroplasty. This will certainly refine our clinical and surgical skills and enable us to deliver better patient services.

We would like to thank our Sponsor - Depuy Synthes for fully funding the program. We are also grateful to the secretaries and event managers who meticulously planned our itineraries for seamless travel and stay in all these places. We express our sincere gratitude to Dr. Rami Sorial and Dr. Parag Sancheti for initiating and organizing this unique traveling fellowship program for budding Arthroplasty surgeons from the Asia Pacific region.

Warm regards.

Dr. Sandesh Madi Sural
Associate Professor, Orthopaedics
Kasturba Medical College, Manipal, India.

Dr. Vishnu Kumar Senthil
Assistant Professor, Orthopaedics
AAORC, Chennai, India.